The existing system of medical care for acute illness among the rapidly expanding population of older adults often serves them poorly. Many factors limit the access of these patients to safe, efficient, high quality, low cost, acute care. Telemedicine, a commercially-available technology with demonstrated effectiveness in other vulnerable populations, may benefit older adults. The Health-e-Access (HeA) telemedicine network is a novel and efficient approach to patient-centered acute illness care, enabling clinicians to evaluate and treat vulnerable older adults in their residences. The proposed study aims to develop and evaluate a telemedicine- enhanced care model that improves access to safe, high quality, acute illness care; fosters appropriate use of health services; and reduces unnecessary expenditures. Specifically, the study will implement HeA within a community network of assisted living residences. It will evaluate hypotheses that telemedicine will decrease the rate of emergency department (ED) use, decrease the net cost of healthcare, decrease hospitalization for ambulatory care sensitive conditions, improve the quality of communications between on-call clinicians and the ED, improve stakeholder satisfaction, and improve patient safety as measured by the AHRQ Survey on Patient Safety. Strategies that promote the implementation, acceptance, and success of HeA in assisted living residences will be determined using qualitative methods. Knowledge acquired will inform efforts to disseminate the HeA enhanced care model widely, in part through toolkit development. Building on prior success of this multidisciplinary research team's members, this study will address both concerns of major stakeholders and AHRQ and Medicare Evidentiary Priorities, including: improved quality and patient safety; more cost-effective care models; evaluation of care provided to older adults with chronic illnesses; assessment of technology's impact of cost and outcomes; and improved access to care. PUBLIC HEALTH RELEVANCE: Project Narrative - Relevance to Public Health. The older adult population in the United States is rapidly expanding, resulting in increased demands for safe, efficient, high-quality, low cost acute care. Many factors limit the availability of this care. The proposed telemedicine program has the potential to obviate these barriers and to improve access to this critical service. Successful study completion will demonstrate the value of telemedicine as part of an acute care model and explicate facilitating and obstructing factors that are critical to its acceptance, sustainability, and dissemination; this, in turn will promote the integration of telemedicine into primary care and emergency medical systems to improve the care of vulnerable, older adults.